CSCO 2017 – Xiamen
Lecture Board: Wang Jie, Shun Lu, You Lu, Yi-long Wu, Caicun Zhou
Medical Writer: Judith Moser, MD
Springer is delighted to announce a new memo inOncology SPECIAL ISSUE congress report in collaboration with CSCO!
2017 CSCO annual meeting memo inOncology congress report
The 20th Chinese Society of Clinical Oncology (CSCO) annual meeting took place in Xiamen from September 26th to 30th, 2017. This congress report summarises the latest findings on lung cancer care that were presented at the congress, including the latest CSCO guidelines for NSCLC, how best to diagnose and treat EGFR-mutated NSCLC, how best to treat lung cancer patients with brain metastases, treatment options for lung squamous cell carcinoma, and the response to immunotherapy.
Preface – CSCO 2017
Dear Colleagues, In the global fight against cancer, clinical trials across multiple regions of the world have become common practice, with the ultimate goal to bring good medicinal products to patients around the world, as fast as scientifically possible. Safety and efficacy data generated from local patients are a regulatory requirement in many countries including China.
Guidelines for the treatment of NSCLC in China: progress and controversies
Lung cancer (LC) is the leading cause of tumor deaths worldwide. Per year, 1.8 million people are diagnosed with LC, and the annual death toll amounts to 1.6 million. Non–small-cell lung cancer (NSCLC) is the most common type, which accounts for 85% of LC cases. Squamous cell carcinoma (SqCC), adenocarcinoma (AC), and large-cell carcinoma are subtypes of NSCLC.
Diagnosis of EGFR-mutated NSCLC: from guidelines to reality
Over the last decade, the increasing understanding of critical molecular and cellular mechanisms which drive tumor initiation, maintenance, and progression in non-small-cell lung cancer (NSCLC) have contributed to the discovery of various novel drug targets and the development of new treatment strategies.
Different therapies for treatment of squamous cell carcinoma
Squamous cell carcinoma (SqCC) is one of the histopathological subtypes of non–small-cell lung cancer (NSCLC), and it accounts for 20 % to 30 % of these patients [1]. Unfortunately, few studies have explored the treatment options for patients with SqCC, and progress in SqCC treatment lags behind other histopathological and/or molecular subtypes of NSCLC [2].
Optimal strategy for the treatment of EGFR-mutant lung cancer
The emergence of EGFR TKIs has changed the standard of care in EGFR-mutant NSCLC patients. IPASS was the first open-label randomized study to compare the first-generation EGFR TKI gefitinib with platinum-based chemotherapy in Chinese patients with EGFR-mutant NSCLC. It showed that the disease-free survival (DFS) rate was remarkably higher in the gefitinib group compared to chemotherapy.
New insights into the treatment of ALK-mutant-positive NSCLC patients
Anaplastic lymphoma kinase (ALK) is a fusion oncogene, and the prevalence of ALK mutations in NSCLC patients is similar across different races. At CSCO 2017, the main progress for the treatment of ALK-mutant-positive NSCLC patients related to the new recommendations for first-line and second-line treatments, and the optimal strategies to manage patients before and after resistance to ALK tyrosine kinase inhibitors (TKIs).
Determination of clinical responses to immunotherapy
In the past 13 years, an earthshaking change has occurred in treatment of non–small-cell lung cancer (NSCLC). The emergence of two new treatment methods – targeted treatment and immunotherapy – has overturned doctors’ and patients’ perception of standard of care for NSCLC. However, not all of the driver oncogenes in NSCLC have been identified.
Combination of targeted therapy with radiotherapy for treatment of brain metastasis
Lung adenocarcinomas often metastasize to the brain, and the prognosis of patients with brain metastases is poor. The EGFR gene is mutated in a considerable fraction of patients with primary lung adenocarcinomas and brain metastases, and especially in Asian patients.
序言
在全球对抗癌症的斗争中,覆盖世界多个地区进行临床试验已成为习惯作法,其最终目的在于以科学上尽可能快的效率为世界各地的患者提供优异的医药产品。从当地患者中获得安全性和疗效数据是包括中国在内的许多国家的监管要求。作为非政府组织,中国临床肿瘤学会(CSCO)每年召开一次学术会议,为国内外肿瘤学研究专业人士提供科学交流平台。9月26日至30日在厦门举行的第20届会议的主题为“传承创新,携手同行”。
中国NSCLC治疗指南:进展与争议
肺癌(LC)是全球肿瘤死亡的首要诱因。每年有180万人被诊断出患有LC,并且每年死亡人数达160万。非小细胞肺癌(NSCLC)是最常见的LC类型,其占LC病例的85%。鳞状细胞癌(SqCC)、腺癌(AC)和大细胞癌是NSCLC亚型。NSCLC的5年生存率仅为15%左右,并且目前近70%的NSCLC患者在诊断时已处于晚期。 中国临床肿瘤学会(CSCO)的LC指南以循证医学和精准医学为基础。但同时也应当考虑卫生资源的可获得性。
EGFR突变NSCLC的诊断:从指南到现实
在过去十年中,对驱动非小细胞肺癌(NSCLC)中肿瘤发生、维持和进展的关键分子和细胞机制的日益了解促进了各种新药物靶点的发现和新治疗策略的开发。晚期NSCLC患者的标准疗法(SOC)正在从基于患者临床病理特征经验性选择疗法转向根据患者肿瘤的分子图谱使用生物标志物驱动的治疗。亚洲患者中最常见的突变是EGFR突变,其出现在60.5%的肺腺癌(AC)患者中。
治疗鳞状细胞癌的不同疗法
鳞状细胞癌(SqCC)是非小细胞肺癌(NSCLC)的组织病理学亚型之一,并且占到NSCLC患者中的20%至30% 。遗憾的是,很少有研究探索SqCC患者的治疗选择,并且SqCC治疗进展滞后于其他NSCLC组织病理学和/或分子亚型。在CSCO 2017年会上,与SqCC相关的主要信息表明,免疫疗法和靶向疗法没有带来令人满意的结果。此外,还报道了阿法替尼用于治疗SqCC患者的最新进展。
用于治疗EGFR突变肺癌的最佳策略
EGFR TKI的出现改变了EGFR突变NSCLC患者的治疗标准。IPASS是在中国EGFR突变NSCLC患者中对第一代EGFR TKI吉非替尼与铂类化疗进行比较的首个开放随机化研究。结果显示,吉非替尼组的无病生存期(DFS)显著高于化疗组。因此,IPASS为在晚期EGFR突变NSCLC患者中使用第一代EGFR TKI奠定了基础。 在2017年CSCO年会上,EGFR靶向治疗相关讨论主要集中于三个主题。第一,用于晚期EGFR突变NSCLC患者的一线、二线和三线标准治疗策略以及可选治疗策略;第二,靶向疗法和放疗联合用于EGFR突变NSCLC患者;第三,关注中国NSCLC患者EGFR靶向治疗研究的相关最新数据和新颖见解。
ALK突变阳性NSCLC患者治疗新见解
间变性淋巴瘤激酶(ALK)是一种融合致癌基因,且NSCLC患者中ALK突变的发生率在不同种族间类似。在2017年CSCO年会上,治疗ALK突变阳性NSCLC患者的主要进展与针对一线和二线治疗的新建议,以及对ALK酪氨酸激酶抑制剂(TKI)产生耐药前后管理患者的最佳策略有关。会议还报道了伴随EGFR-ALK突变患者的管理策略。
免疫疗法临床应答的确定
在过去13年中,非小细胞肺癌(NSCLC)的治疗发生了翻天覆地的变化。两种新治疗方法(靶向治疗和免疫疗法)的出现推翻了之前医生和患者对NSCLC治疗标准的看法。然而,并非所有NSCLC的驱动致癌基因均得到了鉴别。仍有大量具有未知驱动致癌基因突变的患者无法从目前可用的靶向疗法中获益。此外,对这些靶向疗法的获得性耐药无一例外会发生。 免疫疗法的开发基于免疫系统的三大重要特征:特异性、适应性和记忆性。
靶向疗法联合放疗用于治疗脑转移
肺腺癌常常转移到脑部,且脑转移患者的预后较差。在相当一部分原发性肺腺癌和脑转移患者,特别是亚洲患者中发生EGFR基因突变。据2017年CSCO年会上的报告,这些脑转移患者中EGFR突变的发生率在中国台湾约为44%,在日本约为63%,远高于美国或欧洲(0%-2%)。在2017年CSCO年会上,这些脑转移治疗的主要进展集中于驱动致癌基因阳性靶向治疗(伴有或不伴有放疗)的功效,以及放疗与EGFR/ALK酪氨酸激酶抑制剂(TKI)在驱动致癌基因阳性非小细胞肺癌(NSCLC)患者中的最佳用药顺序。
EXPERT VIDEOS
All video interviews from CSCO 2017
Caicun Zhou discusses NSCLC care in China, and the use of molecular targeted agents
Shun Lu discusses the recent clinical trial data for EGFR targeted agents and how this will shape clinical practice, as well as the need for solid clinical trial data revealing how the sequencing of EGFR directed agents affects survival
Clinical trials conducted in Asia have contributed considerably to the development of targeted therapies, such as EGFR or ALK tyrosine kinase inhibitors, and immunotherapies, but also to the implementation of cytotoxic drugs. Particularly in lung cancer, Eastern Asia has evolved into a stronghold of cancer research over the previous years.